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Groups release new guidelines for STEMI treatment

Tuesday December 18, 2012
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New, streamlined guidelines will help healthcare providers better treat patients with ST-elevation myocardial infarction, according to an American Heart Association/American College of Cardiology statement.

The guidelines, published online in the American Heart Association journal Circulation and the Journal of the American College of Cardiology, focus on clinical decision-making at all stages, beginning with the onset of symptoms at home or work, regional systems of care to ensure that patients get immediate treatment and the rapid restoration of flow down the obstructed coronary artery.

The most serious STEMI complications are the emergence of a lethal arrhythmia and heart failure. About 250,000 Americans suffer a STEMI each year.

"Time is of the essence in the evaluation and treatment of these patients," Patrick O’Gara, MD, chairman of the guidelines writing committee, said in a news release. "The sooner blood flow is restored, the better the chances for survival with intact heart function."

Percutaneous coronary intervention is the preferred treatment strategy when it can be done quickly. When there are delays, as may occur when a patient arrives at a facility where intervention is not available, clot-busting drugs should be administered if safe for the individual patient, followed by transfer to a facility where intervention can subsequently be performed if needed.

Among other key points in the new guidelines:

• Improving patient recognition of MI symptoms and the importance of immediately calling 911. Patient delay in reporting symptoms is one of the greatest obstacles to timely and successful care. Travel by private car to the hospital is strongly discouraged.

• Recommending that emergency medical technicians perform electrocardiograms in the field to facilitate more rapid triage and speedier treatment.

• Using hypothermia to treat patients who suffer cardiac arrest. To reduce brain injury in these patients, cooling protocols should be activated before or at the same time of cardiac catheterization.

• Providing care plans at discharge that are clearly communicated and shared with patients, families and other healthcare providers. Referral for cardiac rehabilitation is a key factor. A table in the guidelines itemizes these considerations, including smoking cessation, cholesterol management, social needs, depression and cultural and gender-related factors that may contribute to outcomes.

"We’re looking to a future where more patients survive with less heart damage and function well for years thereafter," said O’Gara, the executive medical director of the Shapiro Cardiovascular Center and director of clinical cardiology at Brigham and Women’s Hospital in Boston. "We hope the guidelines will clarify best practices for healthcare providers across the continuum of care for STEMI patients."

A PDF of the guidelines is available at http://circ.ahajournals.org/content/early/2012/12/17/CIR.0b013e3182742cf6.full.pdf.


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